Healthcare Provider Details

I. General information

NPI: 1801907944
Provider Name (Legal Business Name): LANSING SURGICAL ASSOCIATES, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 S WASHINGTON AVE SUITE 300
LANSING MI
48910-2873
US

IV. Provider business mailing address

2720 S WASHINGTON AVE SUITE 300
LANSING MI
48910-2873
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-8255
  • Fax: 517-487-2059
Mailing address:
  • Phone: 517-487-8255
  • Fax: 517-487-2059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMJ010550
License Number StateMI

VIII. Authorized Official

Name: DR. MARK WAYNE JONES
Title or Position: PRESIDENT
Credential: DO
Phone: 517-487-8255